Using Government Services to Improve the Development and Behaviour of Young Jamaican

Children: Interventions for the Home, the

Clinic and the School

Helen HenninghamSchool of Psychology

Why is early childhood important?

Brain development most rapid and vulnerable from conception to 5 years.

Experiences in early childhood can have lasting effects on children’s ability to learn and their behaviour.

Interventions are more cost-effective than at other ages.

Without quality early childhood care children arrive at formal schooling with deficits in cognitive and social skills. This detrimentally affects their school progress.

Millions of children < 5y not fulfilling their potential in development (WHO, 2006; UNICEF 2006)

Stunted Poverty Disadvantaged< -2z scores < $1/day (Poor &/or stunted) HAZ

156m

126m

219m (39% of children <5y)

Stunted +Poverty not stunted

1. Deficit in grades attained (Brazil)

2. Deficit in learning per grade (Phillipines,

Jamaica)

3. Estimate total deficit (1+2)

20 % loss of yearly adult income

Loss of yearly adult income

Conclusion

Loss of children’s potential is an enormous problem affecting >200million

It has economic and social costs both to individual and nations

Interventions for the Home

Importance of stimulationUnstimulating environments and lack of quality

parent-child interaction are major risk factors for poor development

Stimulation: Weekly 1hr home visits by community health aides. Play session with mother and child. Focus on:• Enhancing

maternal-child interactions

• Language• Praise• Showing mother

how to promote development through play

In Jamaica, we have shown benefits of psychosocial intervention to children’s development as well as mothers’ child rearing knowledge and practices

Children enrolled at age 9-24 months received 2 years of intervention

Followed up at age 22 years

Benefits of Stimulation at age 22y: IQ

p=0.003p=0.004

p=0.02

Benefits of Stimulation at age 22y:Education

p=.004 p=.014

p=.005

Reading Maths General Knowledge

Benefits of Stimulation at age 22y: Psychological Functioning

p=.03 p=.05

Benefits of Stimulation at age 22y: Reduced violent behaviour

p=.04p=.06

Interventions for the Clinic

Parenting DVDs Developed

9 modules (3 minutes each) 1. Love2. Comfort3. Talk to baby4. Bath time5. Toys6. Praise7. Books8. Drawing9. Puzzles

Health Centre Intervention• 3 modules were shown at each Child

Health clinic when the subjects: 3 months 6 months 9 months 12 months 18 months

Group discussion & demonstration with mothers

1. Discuss the video with caregivers− What did they see on the video− What can they do with their baby− Practice− Praise caregivers and label what

they are doing2. Song or Game3. Homemade toy− How to make it− How to use it

During Nurse ConsulationNurse asks mother what she saw on the video

and what she thinks she could tryGives mother a message card and reads it

through with herEncourage mother to try these behaviours at

homeIf the mother has not yet seen the video

encourage her to watch it

Supplements to DVD –Message cards, Books and Puzzles

Interventions for the School

Children with social, emotional and behavioural problems

School entry

Primary school

• Poor relationships with teachers

• Peer rejection

• Poor parent-teacher relationships

•Low participation in the classroom

• Continuing behavior problems• Low level of bonding to school• Associate with deviant peers • Low academic achievement

Primary school

Adolescence

Adulthood

Aggressive & disruptive behaviour

Juvenile delinquencyTruant / dropout from school

Substance abuseDepression & suicide ideation

Crime and violenceAntisocial personality disorderLow educational and economic

attainment

Content1. How to create an emotionally supportive

classroom environment Praise, incentives, play, following child’s interests

2. How to be proactive to prevent problems Classroom rules and routines, keeping children

engaged, ‘with-it-ness’

3. Dealing with child misbehaviours Ignore, redirect, consequences

4. Teaching social skills to children Sharing, asking, waiting, trading

Process

Video vignettes of Jamaican classrooms Group discussion Role plays Practical activities Small group work Classroom assignments In-class support: modelling, coaching & praising

Build on Teachers’ Previous Knowledge Brainstorm at the beginning of each new topic:

Advantages, disadvantages, barriers

What are the advantages of attention, encouragement and praise: To children To teacher-parent relationships To teacher-child relationships

What are the barriers to praising children: In general For the more difficult children

Small Group Activities Activities given to small groups:

e.g. Scenarios involving child misbehaviour and group must decide what strategies they would use

Groups role play their solutions for the whole group

Detailed feedback on strategies used by the group: What was good Why was it good

Whole group brainstorms other strategies that may be used

Classroom Rules: Quiet hand up Walking feet Inside voice Eyes on teacher

Friendship Skills: Sharing Waiting Asking Taking turns

Teaching Skills to Children

Explicitly teach children examples and non-examples of the skill

Have a visual aid Let children role play

the skill Practice the skill in different

contexts during the day Promote children’s use of the skill – e.g.

praise children who are using the skill throughout the regular school day

How to Teach a Skill

In-Class Consultations Boost teacher confidence and

motivate them to use the strategies consistently

Help teachers to problem-solve Help tailor strategies to fit the

classrooms Promote continued use

of strategies over time

Classroom Assignments Practice a specific skill taught

in workshop E.g. Labelled praise, ignore minor

misbehaviour

Record on prepared sheet What child was doing What teacher said / did

Observe and record the effect on child/ren What child did or said How child was feeling

Results: benefits to children

Observations

Baseline Final5

10

15Teacher Report

Baseline Final110

120

130

140

150

160

Parent Report

Baseline Final110

120

130

Change in conduct problems in intervened and control classrooms

Intervened Control

p<0.01 p<0.01

p<0.05

Baseline Final2

4

6

8

10

12

Baseline Final60

65

70

75

80

Baseline Final7

8

Change in friendship skills in intervened and control classrooms

Parent Report

Observations Teacher Report

Intervened Control

p<0.001 p<0.001

p<0.05

Results: benefits to teachers

Baseline Final45

85

125

165

205

Baseline Final50

75

100

125

Teacher Positives Teacher Negatives

Change in observations of teachers’ classroom behaviours in intervened and control classrooms

Intervened Control

p<0.001 p<0.001

p < 0.001; Values are median frequency / 90 minutes of observation

Change in observed teacher interactions to high risk children in intervened and control classrooms

Baseline Final5

10

15

20

25

Baseline Final4

6

8

10

Teacher Positives Teacher Negatives

Intervened Control

p<0.001 p<0.001

p < 0.001; Values are median frequency / hour of observation

Percentage of teachers using physical punishment through observation

Baseline Final0

10

20

30

40

50

60

70

Control

p<0.001

%ns

New InitiativesDeveloping and evaluating an integrated

intervention to promote child development from conception to age 5 to be embedded in existing government services in rural Colombia

(with University de los Andes, Bogota & Institute of Fiscal Studies, London)

Developing and evaluating a combined intervention of CBT for depression and early stimulation for depressed mothers and their infants in rural Bangladesh

(with the International Centre for the Diarrhoeal Disease Research, Bangladesh)

New Initiatives in JamaicaSimplify and scale-up teacher training

intervention for Jamaican preschool teachers

Pilot a consultative model of teacher training with Jamaican primary school teachers

Develop training materials and package the Jamaican home-visiting early stimulation curriculum for global dissemination on-line

Thank you for your attention

Diolch yn Fawr Iawn